Colorado Antimicrobial Stewardship Endeavor (CASE)

About CASE: In August 2021, the Colorado Department of Public Health and Environment partnered with Children’s Hospital Colorado to start the Colorado Antimicrobial Stewardship Endeavor (CASE). CASE includes physicians, pharmacists, and epidemiologists who provide mentorship and resources to Colorado hospitals that may be new to antibiotic stewardship.

children's hospital logo


Through a series of workshops and one-on-one consultations, CASE members support hospital antibiotic stewardship programs to:

  • Develop evidence-based actions to improve antibiotic use, 
  • Develop procedures to track and monitor antibiotic use,
  • Extend antibiotic stewardship activities to pediatric patients,
  • Have a forum for discussion among antibiotic stewards in community hospitals.

CASE also seeks to provide resources such as treatment guidelines, support for reporting antibiotic use to the National Healthcare Safety Network (NHSN), and links to evidence-based guidelines and tools.


About the website: This website will offer updates on CASE activities and links to evidence-based resources to improve antibiotic use in all Colorado hospitals.

CASE contacts:

CASE workshops schedule:

CASE 1-on-1 ASP Consult Sessions

Individuals from our two teams work together to troubleshoot difficulties and help develop plans for improving your stewardship program over a 30-60 min session. These sessions are tailored to your specific needs and situations. If you are interested in scheduling a session or learning more, please contact Michael Bozzella or Lynda Saignaphone (emails above).

A Framework for Antibiotic Stewardship

Antibiotic stewardship programs optimize the treatment of infections while reducing the adverse events associated with antibiotic use. Adverse events include side effects, inadequate treatment of infections, and the creation of antibiotic resistant bacteria and fungi. CDC developed the Core Elements of Hospital Antibiotic Stewardship Programs as a framework for hospitals to build upon. The Core Elements also serve as a standard for quality care. Learn more about the Core Elements and related resources below. * 

CDC’s Core Elements of Hospital Antibiotic Stewardship Programs

Additional Implementation Resources

Antibiotic Stewardship in Colorado Hospitals

*CASE seeks to help hospitals implement activities within the Core Elements framework that are most likely to improve antibiotic use in hospitals.

Clinical Practice Guidelines

Facility-specific clinical practice guidelines serve as a gold standard for antibiotic selection and duration of therapy and are a foundation for antibiotic stewardship program actions. Recommendations should be based on national guidelines but should reflect hospital treatment preferences based on local susceptibilities, treatment options, and patient mix. Facility-specific guidelines should address common indications for antibiotic use like community-acquired pneumonia, urinary tract infection, skin and soft tissue infection, intra-abdominal infection, and surgical prophylaxis.
National Guidelines

Facility-specific guidelines and clinical pathways (examples)

Evidence-Based Actions to Improve Antibiotic Use

Because hospitals may have limited resources for antibiotic stewardship, it is important for antimicrobial stewardship programs to prioritize actions that are most likely to improve antibiotic use. Some actions that are recommended by evidence-based guidelines include:

  • Prospective audit with feedback: an external review of antibiotic therapy by a member of the antibiotic stewardship team, accompanied by suggestions to optimize use, at some point after the agent has been prescribed.
  • Handshake stewardship: rounding-based review of antibiotic therapies by the antibiotic stewardship team with in-person suggestions to optimize use.
  • Preauthorization: prescribers gain approval prior to the use of certain antibiotics designated by the antibiotic stewardship team.

Learn more about these and other recommended pharmacy, microbiology, nursing, and technology actions that are proven to improve antibiotic use in hospitals.

Priority Actions to Improve Antibiotic Use

Additional Resources for Prioritization

Tracking Antibiotic Use

Measurement is critical to identify opportunities for improvement and to assess the impact of interventions. Measurement of antibiotic stewardship interventions may involve evaluation of both processes and outcomes. A priority metric for antibiotic use is antibiotic days of therapy (DOT). A DOT is the total number of days for which a specific antibiotic is given. It is usually expressed as a rate per 1,000 patient-days or days present and can be stratified by location of prescription or antibiotic class. Antibiotic use data can also be used to provide feedback to prescribers. The National Healthcare Safety Network (NHSN) offers an Antibiotic Use and Resistance Module that allows hospitals to track antibiotic DOT in their facility against national benchmarks and submit data to inform public health priorities. Learn more about tracking antibiotic use from the resources below.
National Report

Measures of Antibiotic Use

National Healthcare Safety Network

Antibiotic Resistance

Antibiotic resistance is a public health threat and a key motivator of antibiotic stewardship. Tracking antibiotic resistance can inform public health priorities, provide targets for antibiotic stewardship in hospitals, and give clinicians information necessary to prescribe appropriate antibiotics for patients. See resources for tracking antibiotic resistance below.
Antibiotic Resistance Data and Reports

Microbiology and Antibiograms

National Healthcare Safety Network

Additional Educational Resources

Please see select resources below designed to boost the expertise of antibiotic stewardship program staff and provide education to prescribers and patients.